Outcomes of anaemic patients presenting with acute coronary syndrome (ACS): An analysis of the cooperative national registry of acute coronary care, guideline adherence and clinical events (CONCORDANCE).

Objectives: Anaemia commonly accompanies ACS and is associated with poorer outcomes. This study examines the associations between anaemia, management and outcomes in an Australian ACS population. Method(s): This analysis of the CONCORDANCE database included 8665 ACS patients presenting to 41 Australian hospitals. Baseline characteristics, management and outcomes were compared between patients with anaemia (Hb<=130 for males, Hb<=120 g/L for females) and non-anaemia. Result(s): 1880 (21.7%) patients presenting with ACS were anaemic. These patients were older (72yrs vs. 63yrs, p<0.0001), with higher prevalence of comorbidities. STEMI patients with anaemia were less likely to be emergently reperfused with either thrombolytic therapy (22% vs. 33%, p<0.0001) or primary percutaneous coronary intervention (PCI) (45 vs. 51% p=0.033). For all ACS, anaemic patients less frequently received: coronary angiography (63% vs. 86%, p<0.0001); drug eluting stents if undergoing PCI (50% vs. 58%, p<0.0001); dual antiplatelet therapy (80% vs. 89%, p<0.0001) and parenteral anticoagulants (82% vs. 88%, p<0.0001). Heart failure (20% vs. 9%, p<0.0001), renal failure (13% vs. 4%, p<0.0001), and reinfarction (4% vs. 2%, p=0.0006) were more common among anaemic patients. There was a near-linear relationship between admission haemoglobin and in hospital mortality. Conclusion(s): Anaemic patients with ACS are a high risk group less likely to undergo invasive and antithrombotic therapy. The optimal haemoglobin level in this population warrants further investigation.